Prostheses for the repair of vascular defects, including for example vascular aneurysms, are well known in the art. A common prosthesis for treatment of such a medical condition is a stent-graft.
Prostheses of this type are typically deployed endoluminally through a vein or artery adjacent a surface of a patient. For example, aortic prostheses are commonly fed through the femoral artery. A common method of deployment involves the location of a guide wire along the path to be followed by the introducer assembly, up to the site in the vasculature to be treated. Once the guide wire is in place, a series of catheters is advanced along the guide wire, finally with the introduction of a catheter assembly which carries the stent or stent-graft to be fitted. The catheters have sufficient trackability to follow the guide wire along the curves and turns of the patient's vasculature and some can also curve sufficiently so as to be able to fit a stent-graft, for example, into the aortic arch of a patient.
Even though such a procedure is possible into the aortic arch, it is mired in difficulties as a result of the tight curvature of the latter. One such difficulty arises in connection with the proximal end of the stent-graft, which is liable to be incorrectly fitted such that it incompletely seals around the inner wall of the aorta as a result of the curvature imparted to the stent-graft. This can lead to leakage of blood around the outside of the stent-graft and thus of a less than effective treatment. Furthermore, as a result of the non-optimal placement of the stent-graft using known procedures, there is a limit to the length of neck of healthy vascular wall which is needed to provide a seal around the proximal end of the stent-graft. This limits the application of such stent-grafts, in particular for the treatment of aneurysms close to a branch vessel. In addition, in some instances at least, a part of the proximal end of the stent-graft can remain loosely located in the vessel, leading to premature fatigue failure and thrombus effects.
Attempts have been made to resolve these difficulties. For instance, in the applicant's U.S. Pat. No. 6,974,471, mechanisms are described for imparting a curvature to the stent-graft at the moment of its deployment.
The deployment of stent-grafts and other devices, particularly in the aortic arch, in lumens having short necks of healthy vascular wall and other difficult pathologies also requires very precise placement of the device to ensure a good coupling to healthy tissue and in particular a coupling which has longevity and which provides a fluid tight seal with the vessel wall. Prior art systems do allow for a certain amount of coarse re-positioning of the device, for example by pulling on the proximal end of the device. However, if the device is either fitted too far downstream or pulled too much during fitting, the procedure needs to be repeated, for example by withdrawing the device back into its delivery introducer and starting the deployment operation afresh. Repeating the procedure increases operating time, trauma to the patient and still does not guarantee a successful outcome. In some instances, it is necessary to abort the procedure.